tbuckley/cabot-search huggingface dataset:
Oncology-hospitalist co-management: A model for efficient, high-quality care and education.
Authors: Jensa Catherine Morris, Elizabeth Horn Prsic, Nathaniel Parker, Urs Weber, Erin Ann Gombos, Mathew Kottarathara, Bonnie Elyssa Gould Rothberg, Kerin B. Adelson
Journal: Journal of Clinical Oncology (2022)

1 Background: Our inpatient oncology service at Smilow Cancer Hospital had long lengths of stay, high readmission rates and burnout among outpatient oncologists who rotated as inpatient attendings. With a proposal to improve length of stay by.25 days in the first year, the health system funded the integration of internal medicine hospitalists. Methods: Patients were randomly assigned to one of two oncology teams, allowing for real time outcome comparisons. Hospitalists were added to the Intervention Team and served as the primary attending with oncologists as consultants; Oncologists served as the primary attending on the Traditional Team. The intervention began in July 2021. Outcome metrics included LOS, readmission rate, case volume, early discharge rate, educational rankings, and oncologist satisfaction. A multidisciplinary steering group met to review data, study, and act on outcome metrics. Using Quality Improvement PDSA cycles, outcomes were reported at 3 months (PDSA 1), followed by improvement interventions; then reported again at 6 months (PDSA 2). Results: The Intervention Team achieved a 1.0-day reduction in LOS compared to Traditional team. There was no difference in Severity of Illness score in comparator groups, demonstrating no imbalance in patient population. The Intervention team cared for a 29% higher volume of patients and improved early discharge rate without an increase in readmissions from baseline. Oncologists reported a high level of satisfaction with the program. Housestaff overall educational rankings increased after the introduction of hospitalists (Table). Discussion: Hospitalist comanagement exceeded business plan LOS reduction target without compromise in quality or educational metrics. PDSA 1 identified need for role clarity among physicians, increased oncology teaching, and preservation of resident autonomy; PDSA 2 identified need for increased nursing-physician collaboration. Conclusions: Hospitalist comanagement can effectively reduce oncology LOS without adverse effect on readmission rates, educational outcomes, or oncologist satisfaction with care.[Table: see text]
Are YouTube videos a reliable information source for young women with metastatic breast cancer?
Authors: Nina Morena, Yitzchok Ahisar, Xena Wang, Diana Nguyen, Carrie A. Rentschler, Ari N. Meguerditchian
Journal: Journal of Clinical Oncology (2022)

244 Background: Young women with metastatic breast cancer (MBC) are an underserved population, rendering them susceptible to media sources that lack in credibility and reliability. YouTube (YT) is the most commonly used search engine following Google. This study aims to assess the quality of MBC YT videos and to identify common themes in MBC experiences. Methods: A systematic review of YT videos with search terms “metastatic breast cancer young” was conducted in 08/2021. Title, date uploaded, length, poster identity, number of likes, dislikes, and comments were collected. Understandability, actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT) for audiovisual (A/V) materials; information reliability/quality was assessed with DISCERN. Scoring was done by 3 reviewers. Themes, presence of sponsorships, healthcare professionals’ and patients’ narratives were also reported. Results: 101 videos were identified. Of these, 78.2% were sponsored. Average video length was 14.9 minutes (SD 22.5). Majority were posted by nonprofit groups and breast cancer advocacy organizations. Mean PEMAT A/V score was 78.8% (SD 15.3) and 43.1% (SD 45.2) for understandability and actionability, respectively. Overall, videos had moderate reliability and quality levels; mean DISCERN score was 2.44/5 (SD 0.7). Patient narratives were shared in 63.3% and healthcare professionals in 57.4%. Identified themes include treatment (66.3%), family relationship (45.5%), motherhood (37.6%), terminal status (31.6%), the path to diagnosis (28.7%), and spousal relationship (24.7%). Conclusions: YouTube videos about MBC are highly understandable but demonstrate low to moderate rates of actionability, with low reliability and quality scores. Many have a potential commercial bias. More research is needed to evaluate their impact on patient decisions and possible interventions provided by healthcare institutions.[Table: see text]
Using real-world data to quantify chemotherapy waste at Mayo Clinic.
Authors: Scott A. Soefje, Clayton Irvine, Calvin E. Tucker, Vishal S. Shah
Journal: Journal of Clinical Oncology (2022)

8 Background: At Mayo Clinic, the implementation of an automated chemotherapy dose rounding program has resulted in significant cost savings when doses are rounded down to a vial size, however, the cost burden from drug waste continues to be a significant issue when rounding to a vial size is not within our 10% rounding allowance. The mismatch between drug doses and the marketed vial sizes, along with the limitations to the use of single dose vials is a recognized problem, resulting in billions of dollars of wasted drugs in the United States.The goal of our study was to quantify the cost of the wasted amount of chemotherapy and biologic drugs after the implementation of an automated dose rounding program. Methods: Using the electronic health record (EHR), data was collected for biologic and oncolytic agents administered from 1/1/2019 through 12/31/2021. Drugs with waste documented during preparation and that were administered to cancer patients were selected for analysis. The % of doses with waste documented was calculated based upon the total number of all doses given. The total cost of the drug administered along with the cost of the amount of drug wasted were calculated based upon costs listed in the EHR at the time of administration. Results: For the 3-year period, 446,832 doses were dispensed with 47,626 (10.7%) of those doses having waste documented. The total cost of the drugs with documented waste was $114,323,203 with 21.9% ($25,086,608) accounting sole for wasted drug. Five drugs accounted for 59% of the total cost of the drug waste (Table). When examining individual drugs with a high % of doses with documented waste, methoxsalen, epirubicin, eribulin, topotecan, &amp; bortezomib each had &gt; 70% of doses with a documented wasted amount. Conclusions: Despite having an aggressive institutional dose rounding policy, drug waste still results in considerable and significant costs to the Mayo Clinic System. Our data likely underestimates the total cost of drugs waste given that waste documentation requires manual entry into the EHR at the time of preparation. Our results support the need to create and develop solutions that could lead to reduced waste costs which include re-examining the weight based dosing of drugs, mandating pharmaceutical companies to have vial sizes that more appropriately meet the range of standard dosing, developing more multi-dose vials that can be shared across multiple patients, utilizing closed-system transfer devices to extend beyond-use-dating time, or requiring pharmaceutical companies to reimburse payers and patients for the cost of the amount wasted. Drug waste is still a considerable issue and one that needs to be addressed at a policy level.[Table: see text]
Rates of procedures among those with incidentally detected pulmonary nodules: A real-world data assessment.
Authors: Jeffrey C. Thompson, Stacey DaCosta Byfield, Pamela Hansen, Jamie Tucker, Anil Vachani
Journal: Journal of Clinical Oncology (2022)

405 Background: With the increased utilization of chest computed tomography, incidental pulmonary nodules (PN) are frequently encountered in clinical practice. While several professional guidelines exist on PN management, limited evidence exists regarding the evaluation of PN in clinical practice. We examined the incidence of lung cancer (LC) and utilization of invasive procedures in patients with PNs using real-world data. Methods: We conducted a retrospective cohort study using longitudinal, real-world data with de-identified administrative claims and electronic health records (EHR). The cohort included adults (&gt;18 years) with evidence of newly diagnosed PN (ICD9 793.11, 793.19; ICD10 R91.1*, R91.8*) from 1/2014 to 12/2020 in claims (the first claim identified was considered the index date) and ≥1 lung nodule measurement in the EHR with a note date +/- 30 days from the index date. Continuous enrollment in a commercial or Medicare Advantage plan for 12 months pre- and 12 months post-index was required. Exposure categories were created based on lung nodule size; &lt; 6mm, 6-8mm, &gt; 8mm-15mm, &gt; 15-30mm. During the 12-month follow-up, we identified a diagnosis of invasive lung cancer (≥1 claims for ICD9 162.xx; ICD10 C34.xx) or carcinoma in situ of the lung (ICD9 231.xx; ICD10 D02.xx). Rates of repeat imaging, biopsy, and surgery were examined among patients with (LC cohort) and without lung cancer (benign PN cohort) during the 12-month follow-up period. Results: Among 4,304 patients with a nodule measurement, 4.7% (n = 201) were diagnosed with LC during the follow-up period; 2.1%, 4.2%, 8.2%, and 28.3% among those with lung nodules &lt; 6mm, 6-8mm, &gt; 8-15mm, and &gt; 15-30mm, respectively. As expected, the proportion of patients receiving procedures during the follow-up period was significantly higher in patients with LC compared to those with benign PNs (p &lt; 0.01), regardless of lung nodule size (see column percentages in Table). However, the majority (53%) of all procedures were performed in the benign PN cohort. Among all patients that underwent a procedure during the study period, 63% of bronchoscopy, 49% of TTNB, and 38% of thoracic surgery occurred in patients with benign PNs (see row percentages in Table). Conclusions: Although several professional guidelines exist for the management of incidental PN, there continues to be wide variation in the management of PNs with invasive procedures frequently performed in patients ultimately identified to have benign disease. Methods to improve risk stratification of pulmonary nodules would be of significant clinical utility.[Table: see text]
Association of the Affordable Care Act Medicaid expansion and receipt of palliative care among individuals newly diagnosed with advanced stage cancers.
Authors: Xuesong Han, Kewei Shi, Jingxuan Zhao, Leticia M Nogueira, Ravi Bharat Parikh, Ahmedin Jemal, K. Robin Robin Yabroff
Journal: Journal of Clinical Oncology (2022)

73 Background: Receipt of palliative care is a guideline-based practice but is low among patients with advanced cancer is low in the U.S. Lack of insurance is a major barrier to accessing palliative care. It is unknown, however, whether Medicaid expansion under the Affordable Care Act (ACA) and the associated increase in insurance coverage among individuals diagnosed with cancer has led to increased palliative care. We use a nationwide dataset to examine the association between Medicaid expansion and receipt of palliative care among individuals newly diagnosed with advanced stage cancers. Methods: Individuals aged 18-64 years with newly diagnosed stage-IV solid cancers pre- (2010-2013) and post- (2014-2019) ACA Medicaid expansion were identified from the National Cancer Database. We used difference-in-differences (DD) analyses to estimate the association between Medicaid expansion and changes in receipt of palliative care as part of first-line therapy, adjusting for age group, sex, race/ethnicity, area-level poverty, metropolitan status, comorbidity, facility type, palliative care specialist availability, diagnosis year and state of residence. Stratified analyses were conducted by cancer type and sociodemographic factors. Results: A total of 685,781 individuals diagnosed with stage IV cancers were included from Medicaid expansion (N = 439,142) and non-expansion (N = 246,639) states. The percentage of eligible patients who received palliative care as part of first-line therapy increased from 17.0% pre-ACA to 18.9% post-ACA in Medicaid expansion states and from 15.7% to 16.7% in non-expansion states, resulting in a net increase (DD) of 1.4 (95%CI = 1.0-1.8) percentage points in expansion states after adjusting for sociodemographic and clinical factors. The increase in receipt of palliative care in expansion states compared to non-expansion states was greater for patients with advanced pancreatic (DD = 2.5; 95%CI = 0.8-4.3), colorectal (DD = 2.2; 95%CI = 1.1-3.3), female breast (DD = 1.9; 95%CI = 0.1-3.7), lung (DD = 1.6; 95%CI = 0.7-2.5), oral cavity and pharynx (DD = 1.1;95%CI = 0.5-1.6) cancers, and non-Hodgkin lymphoma (DD = 0.9; 95%CI = 0.2-1.5). The improvement in receipt of palliative care was larger among individuals aged 55-64 years, non-Hispanic White patients, and patients residing in middle-income areas and nonmetropolitan areas. Conclusions: Among individuals newly diagnosed with stage-IV cancer, Medicaid expansion was associated with increases in receipt of palliative care, although overall use was low. Furthermore, the increase varied by cancer type and sociodemographic factors. Improving access to insurance can facilitate access to guideline-based palliative care.
Resident Inpatient Curriculum for Oncology (RICO): Results of a targeted needs assessment performed in the Osler Internal Medicine Residency Program.
Authors: Laura Walsh, Natasha Chida, Sam Brondfield, Ross C. Donehower, Kristen Marrone, Parul Agarwal
Journal: Journal of Clinical Oncology (2022)

365 Background: An important factor contributing to a resident’s interest in oncology training is early and consistent exposure to the field. Currently, completing an inpatient oncology rotation is associated with a decreased interest in pursuing a career in oncology and low resident satisfaction. The reasons for this are multi-factorial, including high task burden and limited dedicated teaching time. Fortunately, prior work has revealed that interest in oncology fellowship training increases when residents receive targeted educational material during their oncology rotations. As part of a multifaceted approach to improve the inpatient curriculum, we conducted a targeted needs assessment at our institution. Our goal is to improve resident satisfaction, clinical competency, and interest in pursuing subspecialty training in oncology by implementing a focused educational intervention. Methods: The Johns Hopkins Hospital is an urban academic medical center where the Osler Internal Medicine Residency Program of approximately 156 housestaff complete their training. A majority of these residents rotate through the inpatient solid tumor service. We performed a targeted needs assessment designed with the ABIM Blueprint, the solid tumor service learning objectives, and ACGME data specific to our program. The survey was created using Qualtrics software and distributed via email to all PGY-1, PGY-2, and PGY-3 residents. Results: 42.9% of residents participated in the survey. 79% of participants indicated they planned to pursue subspecialty training after residency with 21% of those in oncology. Approximately half of participants (45%) had rotated on the solid tumor service. 51% of participants reported barriers to education; the most common barriers identified were patient census and high resident task burden. “On the fly teaching” was the preferred instructional strategy by 70% of participants, followed by in-person didactics and asynchronous videos. The top three areas of interest for content creation were: basics of antineoplastic therapy, tumor lysis syndrome, and immune checkpoint inhibitor toxicities. Conclusions: Resident educational experiences on subspecialty rotations plays a strong role in the ultimate decision to pursue further training. Given the rising need for oncologists nationally, it is imperative that programs identify and address gaps in the educational experience on oncology rotations. Our needs assessment identified several concrete ways to improve resident experience on the Johns Hopkins inpatient solid tumor service. Next steps will include development and implementation of a high-yield resident inpatient curriculum for oncology (RICO), with focused assessments planned throughout the academic year to measure clinical competency, resident satisfaction and ultimately identify areas for further improvement.
Designing and implementing an evidence-based and longitudinal implicit bias training curriculum for school of medicine members and health care providers.
Authors: Lauren M. Hamel, Leah M. Robinson, Marquita Chamblee, Donovan Roy, David W. Dougherty, Beena Sood
Journal: Journal of Clinical Oncology (2022)

159 Background: Implicit biases negatively influence decision making and communication in healthcare. The School of Medicine (SOM) at Wayne State University (WSU), based in the diverse yet segregated city of Detroit, Michigan, has faced the consequences of bias. Fortunately, within SOM/WSU, expertise on the problem of and solutions to implicit bias have flourished. We leveraged that expertise to design and implement a comprehensive and longitudinal implicit bias curriculum for SOM members and healthcare providers, including hematology/oncology faculty, providers, and trainees. We designed the curriculum to satisfy State of Michigan implicit bias training requirements for all healthcare providers. To date, we have implemented two modules. Prior to the second module, we received IRB-approval to recruit curriculum participants as study participants and tested effectiveness. Methods: The curriculum is comprised of 1½ hour modules offered every three months. Topics include how implicit bias influences clinical communication with a focus on the oncology care context, how structural racism influences health policy, among others. To evaluate, we utilize Kirkpatrick’s Four-Level Training Evaluation Model, to assess outcomes at 4 levels: 1. reaction, 2. learning, 3. behavior change and 4. long-term results. After obtaining passive consent from participants, we gathered effectiveness data at levels 1 and 2. Results: We implemented two modules (How Patient and Physician Race-Based Attitudes Influence Clinical Communication &amp; Structural Racism 101: Basic Training for Doctors) in 2021 via Zoom. More than 160 people attended each module with many participants representing oncology-focused hospitals and academic departments. All participants received a certificate of participation as a part of the state requirements for implicit bias training, and CME credit. For Session 2 we asked participants to respond to a survey before (n = 106) and after (n = 35) the session assessing Levels 1 and 2. Participant evaluations (Level 1) were very positive, with many participants noting that they plan to put what they have learned into practice immediately. A common critique was the desire for more topics and more time to discuss. Findings show increased knowledge (Level 2) of structural racism (pre: 92% vs. post: 97%); spatial racism (pre: 87% vs. post: 91%); and how racism influences health policy (pre: 80% vs post: 86%). Conclusions: We successfully implemented a longitudinal implicit bias curriculum for SOM members and healthcare providers. Next steps include continuing to implement and assess the curriculum, and collecting data at Levels 3 and 4. This type of curriculum could be an important tool to decrease bias in cancer care and improve cancer care equity.
Racial disparities in oncology clinical trials.
Authors: Devashish Desai, Swe Swe Hlaing, Aakash Goyal, Alan Keogh
Journal: Journal of Clinical Oncology (2022)

356 Background: Healthcare disparities exist in patients living with cancer which could be due to age, sex, race or sociodemographic variables. This study was undertaken to analyze the racial representation in oncology clinical trial study population of selected cancers over a period of 13 years. Methods: ClinicalTrials.gov was utilized for data collection. Clinical trials in 4 major cancers were filtered using the following criteria in advanced search: Disease, Study type: Interventional (Clinical trial), Study results: Studies with results, Status: Completed, Location: United States, Phase: 3 or 4, Last updated: 01/01/2009 to 01/01/2022. Prostate Cancer (PC), Colorectal Cancer (CRC), Breast Cancer (BC), and Lung Cancer (LC) were included in the study. Data were collected in an Excel spreadsheet and descriptive statistics were used for analysis. Comparison of racial representation was made with the National Cancer Institute Surveillance, Epidemiology and End Results Program (SEER) 2019 data for respective cancers. Results: 165 (52.21%) studies out of 316 studies, which met inclusion criteria, were disclosing racial demographic data. Breaking down into respective cancers, PC had 57.69%, LC had 59.04%, CRC had 44.12%, and BC had 46.28% clinical trials with racial demographic data. Table shows detailed racial demographic data of cancers included with comparison to SEER’s incidence data. Whites/Caucasians (Whites) were the most common race in all the cancer trials, followed by Asian/Pacific Islanders (API) in LC, CRC and BC while Blacks/African Americans (AA) being second common in PC. American Indians/Alaskan Natives (AI/AN) were least represented in all the cancer trials. In comparison to SEER’s 2019 incidence data AA and AI/AN were under-represented in all the included cancer trials, while Whites were over-represented. Conclusions: It is prudent to address the issue of racial disparities in clinical trials. To begin with, it is imperative to include racial demographics in the results, as only 52.21% trials had racial demographic data. AA and AI/AN are under-represented in all the included cancer trials while Whites were over-represented, hindering the generalization of the trial results. It is important to make changes at the grass root level, meaning at the conception of the trial and at the research regulatory level.[Table: see text]